Intracorneal ring segment implantation with epithelium-off accelerated crosslinking for pediatric keratoconus: 7-year retrospective analysis

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Abstract
Purpose: To evaluate long-term clinical outcomes after intracorneal ring segment implantation (ICRS) followed by epithelium-off (epi-off) accelerated crosslinking (A-CXL) in pediatric keratoconus (KC). Setting: Centro de Ojos Quilmes, Buenos Aires, Argentina. Design: Longitudinal retrospective study. Methods: 73 eyes from patients with pediatric KC were included. Outcome measures included uncorrected (UDVA) and corrected distance visual acuity (CDVA), spherical refraction, spherical equivalent (SE), mean keratometry (K m ) with the flattest and steepest (K 2 ) corneal curvatures, and both refractive and corneal astigmatism. Changes from preoperative were assessed at 12 months, 36 months, 60 months, and 84 months. Astigmatism vector analysis was performed using double-angle plots, reporting centroids and mean absolute values. Results: Throughout the follow-up period, significant improvements were observed in visual and keratometric outcomes compared with preoperative values. At 60 months, UDVA and CDVA improved by 0.29 logMAR ( P < .0001; 95% CI, 0.13-0.45) and 0.15 logMAR ( P < .0001; 95% CI, 0.05-0.27), respectively. K m decreased by 2.74 diopters (D) at 60 months ( P = .022; 95% CI, 0.24-5.24), whereas K 2 decreased by 4.01 D at 84 months ( P = .003; 95% CI, 0.96-7.05). Changes in centroids and mean absolute values for both corneal and refractive astigmatism also remained significant during the follow-up. Conclusions: ICRS combined with epi-off A-CXL represents an effective treatment for pediatric KC, providing sustained improvements in visual acuity, keratometry, and both refractive and corneal astigmatism over the follow-up period. These findings support its role as a comprehensive therapeutic approach to halt long-term disease progression and enhance visual function.

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